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Madrid J, Agarwal P, Müller-Peltzer K, Benning L, Selig M, Rolauffs B, Diehl P, Kalbhenn J, Trummer G, Utzolino S, Wengenmayer T, Busch HJ, Stolz D, Rieg S, Panning M, Bamberg F, Schlett CL, Askani E. Cardioprotective effects of vaccination in hospitalized patients with COVID-19. Clin Exp Med 2024; 24:103. [PMID: 38758248 PMCID: PMC11101587 DOI: 10.1007/s10238-024-01367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
COVID-19 vaccination has been shown to prevent and reduce the severity of COVID-19 disease. The aim of this study was to explore the cardioprotective effect of COVID-19 vaccination in hospitalized COVID-19 patients. In this retrospective, single-center cohort study, we included hospitalized COVID-19 patients with confirmed vaccination status from July 2021 to February 2022. We assessed outcomes such as acute cardiac events and cardiac biomarker levels through clinical and laboratory data. Our analysis covered 167 patients (69% male, mean age 58 years, 42% being fully vaccinated). After adjustment for confounders, vaccinated hospitalized COVID-19 patients displayed a reduced relative risk for acute cardiac events (RR: 0.33, 95% CI [0.07; 0.75]) and showed diminished troponin T levels (Cohen's d: - 0.52, 95% CI [- 1.01; - 0.14]), compared to their non-vaccinated peers. Type 2 diabetes (OR: 2.99, 95% CI [1.22; 7.35]) and existing cardiac diseases (OR: 4.31, 95% CI [1.83; 10.74]) were identified as significant risk factors for the emergence of acute cardiac events. Our findings suggest that COVID-19 vaccination may confer both direct and indirect cardioprotective effects in hospitalized COVID-19 patients.
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Affiliation(s)
- Julian Madrid
- Department of Cardiology, Pneumology, Angiology, Acute Geriatrics and Intensive Care, Ortenau Klinikum, Klostenstraße 19, 77933, Lahr/Schwarzwald, Germany.
| | - Prerana Agarwal
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Katharina Müller-Peltzer
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Leo Benning
- University Emergency Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mischa Selig
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Rolauffs
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Diehl
- Department of Cardiology, Pneumology, Angiology, Acute Geriatrics and Intensive Care, Ortenau Klinikum, Klostenstraße 19, 77933, Lahr/Schwarzwald, Germany
| | - Johannes Kalbhenn
- Department of Anesthesiology and Intensive Care Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Trummer
- Department of Cardiovascular Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Utzolino
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans-Jörg Busch
- University Emergency Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daiana Stolz
- Clinic of Respiratory Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center -University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Esther Askani
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Liu H, Xie L, Xing C. Pathogenic bacteria and treatment resistance in older cardiovascular disease patients with lung infection and risk prediction model. Open Life Sci 2023; 18:20220756. [PMID: 38152575 PMCID: PMC10751996 DOI: 10.1515/biol-2022-0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 12/29/2023] Open
Abstract
This study analyzes the distribution of pathogenic bacteria and their antimicrobial susceptibilities in elderly patients with cardiovascular diseases to identify risk factors for pulmonary infections. A risk prediction model is established, aiming to serve as a clinical tool for early prevention and management of pulmonary infections in this vulnerable population. A total of 600 patients were categorized into infected and uninfected groups. Independent risk factors such as older age, diabetes history, hypoproteinemia, invasive procedures, high cardiac function grade, and a hospital stay of ≥10 days were identified through logistic regression. A predictive model was constructed, with a Hosmer-Lemeshow goodness of fit (P = 0.236) and an area under the receiver operating characteristic curve of 0.795, demonstrating good discriminative ability. The model had 63.40% sensitivity and 82.80% specificity, with a cut-off value of 0.13. Our findings indicate that the risk score model is valid for identifying high-risk groups for pulmonary infection among elderly cardiovascular patients. The study contributes to the early prevention and control of pulmonary infections, potentially reducing infection rates in this vulnerable population.
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Affiliation(s)
- Hongbo Liu
- The Municipal Hospital of Qingdao Cadre Health Section, Qingdao, Shandong 266000, China
| | - Liyan Xie
- Qingdao Municipal Hospital, Health Care Clinic, Qingdao, Shandong 266000, China
| | - Cong Xing
- Health Promotion Centre, Baoji Maternal and Child Health Care Hospital, Baoji, Shaanxi 721000, China
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3
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Zhao J, Xie Y, Meng Z, Liu C, Wu Y, Zhao F, Ma X, Christopher TA, Lopez BJ, Wang Y. COVID-19 and cardiovascular complications: updates of emergency medicine. EMERGENCY AND CRITICAL CARE MEDICINE 2023; 3:104-114. [PMID: 38314258 PMCID: PMC10836842 DOI: 10.1097/ec9.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV-2 variants, has become a global pandemic resulting in significant morbidity and mortality. Severe cases of COVID-19 are characterized by hypoxemia, hyper-inflammation, cytokine storm in lung. Clinical studies have reported an association between COVID-19 and cardiovascular disease (CVD). Patients with CVD tend to develop severe symptoms and mortality if contracted COVID-19 with further elevations of cardiac injury biomarkers. Furthermore, COVID-19 itself can induce and promoted CVD development, including myocarditis, arrhythmia, acute coronary syndrome, cardiogenic shock, and venous thromboembolism. Although the direct etiology of SARS-CoV-2 induced cardiac injury remains unknown and under-investigated, it is suspected that it is related to myocarditis, cytokine-mediated injury, microvascular injury, and stress-related cardiomyopathy. Despite vaccinations having provided the most effective approach to reducing mortality overall, an adapted treatment paradigm and regular monitoring of cardiac injury biomarkers is critical for improving outcomes in vulnerable populations at risk for severe COVID-19. In this review, we focus on the latest progress in clinic and research on the cardiovascular complications of COVID-19 and provide a perspective of treating cardiac complications deriving from COVID-19 in Emergency Medicine.
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Affiliation(s)
- Jianli Zhao
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, AL, USA
| | - Yaoli Xie
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zhijun Meng
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
| | - Caihong Liu
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yalin Wu
- Department of Biomedical Engineering, University of Alabama at Birmingham, AL, USA
| | - Fujie Zhao
- Department of Biomedical Engineering, University of Alabama at Birmingham, AL, USA
| | - Xinliang Ma
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Bernard J. Lopez
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yajing Wang
- Emergency Medicine Department, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, AL, USA
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Markers of Infection-Mediated Cardiac Damage in Influenza and COVID-19. Pathogens 2022; 11:pathogens11101191. [PMID: 36297248 PMCID: PMC9607279 DOI: 10.3390/pathogens11101191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/18/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction: Influenza and the coronavirus disease 2019 (COVID-19) are two potentially severe viral infections causing significant morbidity and mortality. The causative viruses, influenza A/B and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) can cause both pulmonary and extra-pulmonary disease, including cardiovascular involvement. The objective of this study was to determine the levels of cardiac biomarkers in hospitalized patients infected with influenza or COVID-19 and their correlation with secondary outcomes. Methods: We performed a retrospective comparative analysis of cardiac biomarkers in patients hospitalized at our department with influenza or COVID-19 by measuring high-sensitivity troponin-T (hs-TnT) and creatinine kinase (CK) in plasma. Secondary outcomes were intensive care unit (ICU) admission and all-cause in-hospital mortality. Results: We analyzed the data of 250 influenza patients and 366 COVID-19 patients. 58.6% of patients with influenza and 46.2% of patients with COVID-19 presented with increased hs-TnT levels. Patients of both groups with increased hs-TnT levels were significantly more likely to require ICU treatment or to die during their hospital stay. Compared with COVID-19, cardiac biomarkers were significantly higher in patients affected by influenza of all age groups, regardless of pre-existing cardiovascular disease. In patients aged under 65 years, no significant difference in ICU admission and mortality was detected between influenza and COVID-19, whereas significantly more COVID-19 patients 65 years or older died or required intensive care treatment. Conclusions: Our study shows that increased cardiac biomarkers are associated with higher mortality and ICU admission in both, influenza and SARS-CoV-2-infected patients. Cardiac biomarkers are higher in the influenza cohort; however, this does not translate into worse outcomes when compared with the COVID-19 cohort.
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Nordenskjöld AM, Johansson N, Sunnefeldt E, Athlin S, Fröbert O. Prevalence and prognostic implications of myocardial injury in patients with influenza. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac051. [PMID: 36105869 PMCID: PMC9464904 DOI: 10.1093/ehjopen/oeac051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 11/12/2022]
Abstract
Aims Influenza may cause myocardial injury and trigger acute cardiovascular events. The aim of this study was to investigate the prevalence and prognostic implications of elevated high-sensitivity cardiac troponin I (hs-cTnI) in patients with influenza. Methods and results In this prospective cohort study, we consecutively enrolled patients with influenza-like illness from two emergency departments in Sweden during three seasons of influenza, 2017–20. Ongoing Influenza infection was diagnosed by polymerase chain reaction and blood samples were collected for later analysis of hs-cTnI. All patients were followed-up for a composite endpoint of major adverse cardiovascular events (MACE) including death, myocardial infarction, unstable angina, heart failure, atrial fibrillation, and stroke within 1 year. Of the 466 patients with influenza-like symptoms, 181 (39%) were positive for influenza. Fifty (28%) patients were hospitalized. High-sensitivity cTnI was elevated in 11 (6%) patients and 8 (4%) experienced MACE. In univariate analyses, MACE was associated with age [hazard ratio (HR): 1.14, 95% confidence interval (CI): 1.05–1.23], hypertension (HR 5.56, 95%CI: 1.12–27.53), estimated glomerular filtration rate (HR: 0.94, 95%CI: 0.91–0.97), and elevated hs-cTnI (HR: 18.29, 95%CI: 4.57–73.24), N-terminal prohormone of brain natriuretic peptide (HR: 14.21, 95%CI: 1.75–115.5), hs-CRP (HR: 1.01, 95%CI: 1.00–1.02), and white blood cell count (HR: 1.12, 95%CI: 1.01–1.25). In multivariate analysis, elevated hs-cTnI was independently associated with MACE (HR: 4.96, 95%CI: 1.10–22.41). Conclusion The prevalence of elevated hs-cTnI is low in unselected patients with influenza. Elevated hs-cTnI was associated with poor prognosis. A limitation is that the estimated associations are uncertain due to few events.
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Affiliation(s)
- Anna M Nordenskjöld
- Department of Cardiology, Faculty of Medicine and Health, Örebro University , 70281 Örebro , Sweden
| | - Niklas Johansson
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University , 70281 Örebro , Sweden
| | - Erik Sunnefeldt
- Department of Cardiology, Faculty of Medicine and Health, Örebro University , 70281 Örebro , Sweden
| | - Simon Athlin
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University , 70281 Örebro , Sweden
| | - Ole Fröbert
- Department of Cardiology, Faculty of Medicine and Health, Örebro University , 70281 Örebro , Sweden
- Steno Diabetes Center Aarhus, Aarhus University Hospital , 8200 Aarhus N , Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University , 8000 Aarhus , Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital , 8200 Aarhus N , Denmark
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6
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Association among myocardial injury and mortality in Influenza: A prospective cohort study. Int J Cardiol 2022; 369:48-53. [DOI: 10.1016/j.ijcard.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/17/2022] [Accepted: 08/04/2022] [Indexed: 12/12/2022]
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High-Sensitivity Troponin T: A Potential Safety Predictive Biomarker for Discharge from the Emergency Department of Patients with Confirmed Influenza. J Pers Med 2022; 12:jpm12040520. [PMID: 35455636 PMCID: PMC9031799 DOI: 10.3390/jpm12040520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/23/2022] Open
Abstract
The purpose of the study was to analyze the relationship between the high-sensitivity troponin T levels in patients with confirmed influenza virus infection and its severity determined by mortality during the care process. In addition, a high-sensitivity troponin T cut-off value was sought to allow us to a safe discharge from the emergency department. An analytical retrospective observational study was designed in which high-sensitivity troponin T is determined as an exposure factor, patients are followed until the resolution of the clinical picture, and the frequency of mortality is analyzed. We included patients ≥ 16 years old with confirmed influenza virus infection and determination of high-sensitivity troponin T. One hundred twenty-eight patients were included (96.9% survivors, 3.1% deceased). Mean and median blood levels of high-sensitivity troponin T of survivors were 26.2 ± 58.3 ng/L and 14.5 ng/L (IQR 16 ng/L), respectively, and were statistically different when compared with those of the deceased patients, 120.5 ± 170.1 ng/L and 40.5 ng/L (IQR 266.5 ng/L), respectively, p = 0.012. The Youden index using mortality as the reference method was 0.76, and the cut-off value associated with this index was 24 ng/L (sensitivity 100%, specificity 76%, NPV 100%, PPV 4%) with AUC of 88,8% (95% CI: 79.8−92.2%), p < 0.001. We conclude that high-sensitivity troponin T levels in confirmed virus influenza infection are a good predictor of mortality in our population, and this predictor is useful for safely discharging patients from the emergency department.
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8
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Jirak P, van Almsick V, Dimitroulis D, Mirna M, Seelmaier C, Shomanova Z, Wernly B, Semo D, Dankl D, Mahringer M, Lichtenauer M, Hoppe UC, Reinecke H, Pistulli R, Larbig R, Motloch LJ. Dexamethasone Improves Cardiovascular Outcomes in Critically Ill COVID-19, a Real World Scenario Multicenter Analysis. Front Med (Lausanne) 2022; 9:808221. [PMID: 35186995 PMCID: PMC8847392 DOI: 10.3389/fmed.2022.808221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/12/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Severe COVID-19 pneumonia requiring intensive care treatment remains a clinical challenge to date. Dexamethasone was reported as a promising treatment option, leading to a reduction of mortality rates in severe COVID-19 disease. However, the effect of dexamethasone treatment on cardiac injury and pulmonary embolism remains largely elusive. METHODS In total 178 critically ill COVID-19 patients requiring intensive care treatment and mechanical ventilation were recruited in three European medical centres and included in the present retrospective study. One hundred thirteen patients (63.5%) were treated with dexamethasone for a median duration of 10 days (IQR 9-10). Sixty five patients (36.5%) constituted the non-dexamethasone control group. RESULTS While peak inflammatory markers were reduced by dexamethasone treatment, the therapy also led to a significant reduction in peak troponin levels (231 vs. 700% indicated as relative to cut off value, p = 0.001). Similar, dexamethasone resulted in significantly decreased peak D-Dimer levels (2.16 mg/l vs. 6.14 mg/l, p = 0.002) reflected by a significant reduction in pulmonary embolism rate (4.4 vs. 20.0%, p = 0.001). The antithrombotic effect of dexamethasone treatment was also evident in the presence of therapeutic anticoagulation (pulmonary embolism rate: 6 vs. 34.4%, p < 0.001). Of note, no significant changes in baseline characteristics were observed between the dexamethasone and non-dexamethasone group. CONCLUSION In severe COVID-19, anti-inflammatory effects of dexamethasone treatment seem to be associated with a significant reduction in myocardial injury. Similar, a significant decrease in pulmonary embolism, independent of anticoagulation, was evident, emphasizing the beneficial effect of dexamethasone treatment in severe COVID-19.
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Affiliation(s)
- Peter Jirak
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Vincent van Almsick
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Dimitrios Dimitroulis
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Moritz Mirna
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Clemens Seelmaier
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Zornitsa Shomanova
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Bernhard Wernly
- Department of Anesthesiology, Perioperative Care, and Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Center for Public Health and Healthcare Research, Paracelsus Medical University, Salzburg, Austria
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Dilvin Semo
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Daniel Dankl
- Department of Anesthesiology, Perioperative Care, and Intensive Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Magdalena Mahringer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Uta C. Hoppe
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Rudin Pistulli
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Münster, Germany
| | - Robert Larbig
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lukas J. Motloch
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Ramoğlu MG, Karagözlü S, Bayram Ö, Bakhtiyarzada J, Aydın A, Vatansever G, Özdemir H, Tekin D, Uçar T, Çiftçi E, Tutar E. The role and efficacy of routine high-sensitivity troponin T screening in paediatric COVID-19. Cardiol Young 2022; 32:1-5. [PMID: 34986921 DOI: 10.1017/s1047951121005199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We aimed to evaluate the efficacy and role of high-sensitivity troponin T in children with a confirmed SARS-CoV-2 infection and also the correlation of troponin T levels with symptoms, and echocardiographic findings were analysed. METHODS Two hundred and fourteen patients with a confirmed SARS-CoV-2 infection between the dates of 28 March and 15 August 12020 were enrolled in this retrospective single-centre study. Patients with comorbidities and diagnosed as multisystem inflammatory syndrome in children were excluded. Demographic data, clinical and laboratory parameters were evaluated. The patients were classified and compared according to the troponin positivity. The correlation of troponin T with symptoms and echocardiographic findings was analysed. RESULTS The most common symptoms in the whole study group were fever (53.3%) and cough (24.8%). Troponin T levels were elevated in 15 (7%) patients. The most common symptom in patients with troponin positivity was also fever (73.3%). Troponin T positivity was significantly higher in patients under the age of 12 months and troponin T levels were negatively correlated with age. C-reactive protein levels were elevated in 77 (36%) of the patients in the whole group and 7 (46.7%) of 15 patients with troponin positivity. C-reactive protein levels were similar between groups. CONCLUSION Routine troponin screening does not yield much information in previously healthy paediatric COVID-19 patients without any sign of myocardial dysfunction. Elevated troponin levels may be observed but it is mostly a sign of myocardial injury without detectable myocardial dysfunction in this group of patients.
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Affiliation(s)
- Mehmet G Ramoğlu
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Selen Karagözlü
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Özlem Bayram
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Jeyhun Bakhtiyarzada
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Alperen Aydın
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Göksel Vatansever
- Department of Pediatric Emergency Medicine, Ankara University, School of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Department of Pediatric Infectious Diseases, Ankara University, School of Medicine, Ankara, Turkey
| | - Deniz Tekin
- Department of Pediatric Emergency Medicine, Ankara University, School of Medicine, Ankara, Turkey
| | - Tayfun Uçar
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
| | - Ergin Çiftçi
- Department of Pediatric Infectious Diseases, Ankara University, School of Medicine, Ankara, Turkey
| | - Ercan Tutar
- Department of Pediatric Cardiology, Ankara University, School of Medicine, Ankara, Turkey
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Acute Cardiac Injury in Coronavirus Disease 2019 and Other Viral Infections-A Systematic Review and Meta-Analysis. Crit Care Med 2021; 49:1558-1566. [PMID: 33870918 DOI: 10.1097/ccm.0000000000005026] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Severe acute respiratory syndrome-related coronavirus-2 binds and inhibits angiotensin-converting enzyme-2. The frequency of acute cardiac injury in patients with coronavirus disease 2019 is unknown. The objective was to compare the rates of cardiac injury by angiotensin-converting enzyme-2-binding viruses from viruses that do not bind to angiotensin-converting enzyme-2. DATA SOURCES We performed a systematic review of coronavirus disease 2019 literature on PubMed and EMBASE. STUDY SELECTION We included studies with ten or more hospitalized adults with confirmed coronavirus disease 2019 or other viral pathogens that described the occurrence of acute cardiac injury. This was defined by the original publication authors or by: 1) myocardial ischemia, 2) new cardiac arrhythmia on echocardiogram, or 3) new or worsening heart failure on echocardiogram. DATA EXTRACTION We compared the rates of cardiac injury among patients with respiratory infections with viruses that down-regulate angiotensin-converting enzyme-2, including H1N1, H5N1, H7N9, and severe acute respiratory syndrome-related coronavirus-1, to those with respiratory infections from other influenza viruses that do not bind angiotensin-converting enzyme-2, including Influenza H3N2 and influenza B. DATA SYNTHESIS Of 57 studies including 34,072 patients, acute cardiac injury occurred in 50% (95% CI, 44-57%) of critically ill patients with coronavirus disease 2019. The overall risk of acute cardiac injury was 21% (95% CI, 18-26%) among hospitalized patients with coronavirus disease 2019. In comparison, 37% (95% CI, 26-49%) of critically ill patients with other respiratory viruses that bind angiotensin-converting enzyme-2 (p = 0.061) and 12% (95% CI, 7-22%) of critically ill patients with other respiratory viruses that do not bind angiotensin-converting enzyme-2 (p < 0.001) experienced a cardiac injury. CONCLUSIONS Acute cardiac injury may be associated with whether the virus binds angiotensin-converting enzyme-2. Acute cardiac injury occurs in half of critically ill coronavirus disease 2019 patients, but only 12% of patients infected by viruses that do not bind to angiotensin-converting enzyme-2.
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11
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Lippi G, Sanchis-Gomar F. Cardiac troponin elevation in patients with influenza virus infections. Biomed J 2021; 44:183-189. [PMID: 33097442 PMCID: PMC8178554 DOI: 10.1016/j.bj.2020.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 01/05/2023] Open
Abstract
The association between acute infections and cardiac injury, including myocarditis and acute myocardial infarction, is now well established. We have performed a systematic literature review for analyzing the results of epidemiological studies that measured cardiac troponins (cTn) in patients with Influenza virus infections. Overall, 14 articles were finally identified and analyzed. Taken together, the results of the scientific literature suggest that cTn elevation is a relatively rare phenomenon in patients with Influenza virus infection, with frequency generally comprised between 0 and 33%, more likely in elderly patients with significant comorbidities. In patients with modest cTn elevations, this phenomenon is apparently self-limited, transient and reversible, and especially involves patients with Influenza A (especially H1N1). In the minority of patients exhibiting an abrupt appearance of cardiovascular symptoms and concomitant elevation of cTn values, the relative increase of this biomarker reflects the presence of an underlying cardiac injury, that can be either myocarditis or an acute ischemic episode. Enhanced cTn values can also be more frequently observed in Influenza patients with complicated disease, in those developing acute respiratory distress syndrome and cardiac dysfunction, as well as in those at higher risk of death. cTn measurement shall be considered a valuable option in all patients developing acute cardiovascular symptoms during Influenza virus infections, as well as in those bearing cardiac or extra-cardiac comorbidities who bear a higher risk of complications.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.
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12
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Ali J, Khan FR, Ullah R, Hassan Z, Khattak S, Lakhta G, Zad Gul N, Ullah R. Cardiac Troponin I Levels in Hospitalized COVID-19 Patients as a Predictor of Severity and Outcome: A Retrospective Cohort Study. Cureus 2021; 13:e14061. [PMID: 33898144 PMCID: PMC8061753 DOI: 10.7759/cureus.14061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction The COVID-19 (coronavirus disease) has affected millions of people, wreaking havoc worldwide. World Health Organization (WHO) labelled this disease as a serious threat to public health since its rapid spread from Wuhan, China. The respiratory manifestations of COVID-19 are common, but myocardium involvement causing myocardial injury and rise in cardiac markers is much less discussed. Materials and methods We conducted this retrospective cohort study from 1st April 2020 to 1st October 2020. Data was collected from the Hospital Management and Information System (HMIS) based on inclusion criteria. We used the Cox proportional hazard regression model for survival analysis, estimated the probability curves of survival using the Kaplan-Meier method, and contrasted it with the log-rank test. Results Among the 466 patients, 280 (69%) were male; the rest were female. The majority were both hypertensive and diabetic, and one-third had a myocardial injury on arrival. The most frequent symptoms in more than half of the patients (51.90%) included a combination of fever, dry cough, and shortness of breath. Out of 466 patients, 266 patients were discharged, and 200 did not survive. In our study, 168 (36.05%) patients had a cardiac injury; among them, 38 (22.61%) were in the discharge group, and the remaining 130 (77.39%) patients were in the nonsurvivor group. Our study results showed that the mortality rate was higher in patients with high cardiac troponin I (cTnI) levels (hazard ratio [HR] 3.61) on admission. Conclusion Our result concluded that measuring cTnI levels on presentation could help predict the severity and outcome in COVID-19 patients. It will allow physicians to triage patients and decrease mortality.
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Affiliation(s)
- Jabar Ali
- Cardiology/Interventional Cardiology, Lady Reading Hospital, Peshawar, PAK
| | - Fahad R Khan
- Cardiology, Lady Reading Hospital, Peshawar, PAK
| | - Rizwan Ullah
- Cardiology, Lady Reading Hospital, Peshawar, PAK
| | - Zair Hassan
- Cardiology, Lady Reading Hospital, Peshawar, PAK
| | | | - Gul Lakhta
- Gynecology and Obstetrics, Lady Reading Hospital, Peshawar, PAK
| | - Nooh Zad Gul
- Cardiology, Lady Reading Hospital, Peshawar, PAK
| | - Rahman Ullah
- Cardiology, Lady Reading Hospital, Peshawar, PAK
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13
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Siegers JY, Novakovic B, Hulme KD, Marshall RJ, Bloxham CJ, Thomas WG, Reichelt ME, Leijten L, van Run P, Knox K, Sokolowski KA, Tse BWC, Chew KY, Christ AN, Howe G, Bruxner TJC, Karolyi M, Pawelka E, Koch RM, Bellmann-Weiler R, Burkert F, Weiss G, Samanta RJ, Openshaw PJM, Bielefeldt-Ohmann H, van Riel D, Short KR. A High-Fat Diet Increases Influenza A Virus-Associated Cardiovascular Damage. J Infect Dis 2021; 222:820-831. [PMID: 32246148 DOI: 10.1093/infdis/jiaa159] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/02/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Influenza A virus (IAV) causes a wide range of extrarespiratory complications. However, the role of host factors in these complications of influenza virus infection remains to be defined. METHODS Here, we sought to use transcriptional profiling, virology, histology, and echocardiograms to investigate the role of a high-fat diet in IAV-associated cardiac damage. RESULTS Transcriptional profiling showed that, compared to their low-fat counterparts (LF mice), mice fed a high-fat diet (HF mice) had impairments in inflammatory signaling in the lung and heart after IAV infection. This was associated with increased viral titers in the heart, increased left ventricular mass, and thickening of the left ventricular wall in IAV-infected HF mice compared to both IAV-infected LF mice and uninfected HF mice. Retrospective analysis of clinical data revealed that cardiac complications were more common in patients with excess weight, an association which was significant in 2 out of 4 studies. CONCLUSIONS Together, these data provide the first evidence that a high-fat diet may be a risk factor for the development of IAV-associated cardiovascular damage and emphasizes the need for further clinical research in this area.
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Affiliation(s)
- Jurre Y Siegers
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Boris Novakovic
- Epigenetics Research, Murdoch Children's Research Institute and Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Katina D Hulme
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Rebecca J Marshall
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Conor J Bloxham
- School of Biomedical Science, The University of Queensland, Brisbane, Australia
| | - Walter G Thomas
- School of Biomedical Science, The University of Queensland, Brisbane, Australia
| | - Mellissa E Reichelt
- School of Biomedical Science, The University of Queensland, Brisbane, Australia
| | - Lonneke Leijten
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter van Run
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Karen Knox
- Preclinical Imaging Facility, Translational Research Institute Australia, Brisbane, Australia
| | - Kamil A Sokolowski
- Preclinical Imaging Facility, Translational Research Institute Australia, Brisbane, Australia
| | - Brian W C Tse
- Preclinical Imaging Facility, Translational Research Institute Australia, Brisbane, Australia
| | - Keng Yih Chew
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Angelika N Christ
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Greg Howe
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Timothy J C Bruxner
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Mario Karolyi
- Department for Infectious Diseases, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Erich Pawelka
- Department for Infectious Diseases, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Rebecca M Koch
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Francesco Burkert
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Romit J Samanta
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Peter J M Openshaw
- Respiratory Infection Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Helle Bielefeldt-Ohmann
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia.,Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia
| | - Debby van Riel
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Kirsty R Short
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia.,Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia
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14
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Khan MS, Shahid I, Anker SD, Solomon SD, Vardeny O, Michos ED, Fonarow GC, Butler J. Cardiovascular implications of COVID-19 versus influenza infection: a review. BMC Med 2020; 18:403. [PMID: 33334360 PMCID: PMC7746485 DOI: 10.1186/s12916-020-01816-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Due to the overlapping clinical features of coronavirus disease 2019 (COVID-19) and influenza, parallels are often drawn between the two diseases. Patients with pre-existing cardiovascular diseases (CVD) are at a higher risk for severe manifestations of both illnesses. Considering the high transmission rate of COVID-19 and with the seasonal influenza approaching in late 2020, the dual epidemics of COVID-19 and influenza pose serious cardiovascular implications. This review highlights the similarities and differences between influenza and COVID-19 and the potential risks associated with coincident pandemics. MAIN BODY COVID-19 has a higher mortality compared to influenza with case fatality rate almost 15 times more than that of influenza. Additionally, a significantly increased risk of adverse outcomes has been noted in patients with CVD, with ~ 15 to 70% of COVID-19 related deaths having an underlying CVD. The critical care need have ranged from 5 to 79% of patients hospitalized due to COVID-19, a proportion substantially higher than with influenza. Similarly, the frequency of vascular thrombosis including deep venous thrombosis and pulmonary embolism is markedly higher in COVID-19 patients compared with influenza in which vascular complications are rarely seen. Unexpectedly, while peak influenza season is associated with increased cardiovascular hospitalizations, a decrease of ~ 50% in cardiovascular hospitalizations has been observed since the first diagnosed case of COVID-19, owing in part to deferred care. CONCLUSION In the coming months, increasing efforts towards evaluating new interventions will be vital to curb COVID-19, especially as peak influenza season approaches. Currently, not enough data exist regarding co-infection of COVID-19 with influenza or how it would progress clinically, though it may cause a significant burden on an already struggling health care system. Until an effective COVID-19 vaccination is available, high coverage of influenza vaccination should be of utmost priority.
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Affiliation(s)
| | - Izza Shahid
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Stefan D Anker
- Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Scott D Solomon
- Brigham and Women's Hospital, Heart & Vascular Center, Boston, MA, USA
| | | | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA.
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15
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Sharma Y, Horwood C, Chua A, Hakendorf P, Thompson C. Prognostic impact of high sensitive troponin in predicting 30-day mortality among patients admitted to hospital with influenza. IJC HEART & VASCULATURE 2020; 32:100682. [PMID: 33354619 PMCID: PMC7744942 DOI: 10.1016/j.ijcha.2020.100682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/05/2022]
Abstract
Background Worldwide, seasonal influenza causes significant mortality and severe infections may cause cardiac injury. High-sensitive-troponins (hsTnT) are sensitive and specific markers of myocardial damage. This study investigated the prognostic impact of hsTnT on 30-day mortality in hospitalised influenza patients. Methods This retrospective study included influenza patients ≥ 18 years, who had hsTnT performed during admission in two tertiary-hospitals in South Australia. Diagnosis of influenza was confirmed by polymerase–chain-reaction (PCR) test and hsTnT > 14 ng/L with a change of > 20% during admission was considered to be indicative of acute-cardiac injury. Clinical characteristics, complications and 30-day mortality were compared among four groups of patients: hsTnT unavailable, hsTnT negative, chronically elevated hsTnT and acutely elevated hsTnT. Cox-proportional hazard regression determined the hazard of death at 30-days following hospital discharge after adjustment for co-variates. Results Between January 2016 -March 2020, 1828 influenza patients, mean age 66.4 years, were hospitalised. Troponin results were available for 617 (47.7%) patients, of whom, 62 (10%) had acute myocardial injury and 232 (37.6%) had chronic hsTnT elevation. Both inpatient and 30-day mortality were significantly higher among patients with acute (P < 0.001) and chronic hsTnT (P < 0.001) when compared to other groups. When compared to patients with negative hsTnT, acute but not chronic hsTnT elevation was significantly associated with 30-day mortality after adjustment for various co-variates (HR 8.30, 1.80–17.84, P value = 0.013). Conclusions This is the largest available analysis of cardiac-specific biomarker hsTnT in patients with influenza. An acutely elevated hsTnT was associated with 30-day mortality among hospitalised influenza patients.
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Affiliation(s)
- Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Department of General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Chris Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Angela Chua
- Department of Medicine, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Paul Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Campbell Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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16
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Dou Q, Wei X, Zhou K, Yang S, Jia P. Cardiovascular Manifestations and Mechanisms in Patients with COVID-19. Trends Endocrinol Metab 2020; 31:893-904. [PMID: 33172748 PMCID: PMC7566786 DOI: 10.1016/j.tem.2020.10.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/31/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) patients with pre-existing cardiovascular disease (CVD) or with cardiovascular complications have a higher risk of mortality. The main cardiovascular complications of COVID-19 include acute cardiac injury, acute myocardial infarction (AMI), myocarditis, arrhythmia, heart failure, shock, and venous thromboembolism (VTE)/pulmonary embolism (PE). COVID-19 can cause cardiovascular complications or deterioration of coexisting CVD through direct or indirect mechanisms, including viral toxicity, dysregulation of the renin-angiotensin-aldosterone system (RAAS), endothelial cell damage and thromboinflammation, cytokine storm, and oxygen supply-demand mismatch. We systematically review cardiovascular manifestations, histopathology, and mechanisms of COVID-19, to help to formulate future research goals and facilitate the development of therapeutic management strategies.
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Affiliation(s)
- Qingyu Dou
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kehua Zhou
- Department of Hospital Medicine, ThedaCare Regional Medical Center-Appleton, Appleton, WI, USA; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Hong Kong, China.
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17
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Zhao BC, Liu WF, Lei SH, Zhou BW, Yang X, Huang TY, Deng QW, Xu M, Li C, Liu KX. Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis. J Intensive Care 2020; 8:88. [PMID: 33292649 PMCID: PMC7682759 DOI: 10.1186/s40560-020-00508-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The clinical significance of cardiac troponin measurement in patients hospitalised for coronavirus disease 2019 (covid-19) is uncertain. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality. METHODS Studies were identified by searching electronic databases and preprint servers. We included studies of hospitalised covid-19 patients that reported the frequency of troponin elevations above the upper reference limit and/or the association between troponins and mortality. Meta-analyses were performed using random-effects models. RESULTS Fifty-one studies were included. Elevated troponins were found in 20.8% (95% confidence interval [CI] 16.8-25.0 %) of patients who received troponin test on hospital admission. Elevated troponins on admission were associated with a higher risk of subsequent death (risk ratio 2.68, 95% CI 2.08-3.46) after adjusting for confounders in multivariable analysis. The pooled sensitivity of elevated admission troponins for predicting death was 0.60 (95% CI 0.54-0.65), and the specificity was 0.83 (0.77-0.88). The post-test probability of death was about 42% for patients with elevated admission troponins and was about 9% for those with non-elevated troponins on admission. There was significant heterogeneity in the analyses, and many included studies were at risk of bias due to the lack of systematic troponin measurement and inadequate follow-up. CONCLUSION Elevated troponins were relatively common in patients hospitalised for covid-19. Troponin measurement on admission might help in risk stratification, especially in identifying patients at high risk of death when troponin levels are elevated. High-quality prospective studies are needed to validate these findings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020176747.
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Affiliation(s)
- Bing-Cheng Zhao
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Wei-Feng Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Shao-Hui Lei
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Bo-Wei Zhou
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Xiao Yang
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Tong-Yi Huang
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Qi-Wen Deng
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Miao Xu
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Cai Li
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Ke-Xuan Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China.
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18
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Lavie CJ, Sanchis-Gomar F, Lippi G. Cardiac Injury in COVID-19-Echoing Prognostication. J Am Coll Cardiol 2020; 76:2056-2059. [PMID: 33121711 PMCID: PMC7588173 DOI: 10.1016/j.jacc.2020.08.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain. https://twitter.com/Fabiansango
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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19
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Pitscheider L, Karolyi M, Burkert FR, Helbok R, Wanschitz JV, Horlings C, Pawelka E, Omid S, Traugott M, Seitz T, Zoufaly A, Lindeck-Pozza E, Wöll E, Beer R, Seiwald S, Bellmann-Weiler R, Hegen H, Löscher WN. Muscle involvement in SARS-CoV-2 infection. Eur J Neurol 2020; 28:3411-3417. [PMID: 32997370 PMCID: PMC7537196 DOI: 10.1111/ene.14564] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/09/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Since the outbreak of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, several reports indicated neurological involvement in COVID-19 disease. Muscle involvement has also been reported as evidenced by creatine kinase (CK) elevations and reports of myalgia. METHODS Creatine kinase, markers of inflammation, pre-existing diseases and statin use were extracted from records of Austrian hospitalised COVID-19 patients. Disease severity was classified as severe in case of intensive care unit (ICU) admission or mortality. COVID-19 patients were additionally compared to an historical group of hospitalised influenza patients. RESULTS Three hundred fifty-one patients with SARS-CoV-2 and 258 with influenza were included in the final analysis. CK was elevated in 27% of COVID-19 and in 28% of influenza patients. CK was higher in severe COVID-19 as were markers of inflammation. CK correlated significantly with inflammation markers, which had an independent impact on CK when adjusted for demographic variables and disease severity. Compared to influenza patients, COVID-19 patients were older, more frequently male, had more comorbidities, and more frequently had a severe disease course. Nevertheless, influenza patients had higher baseline CK than COVID-19, and 35.7% of intensive care unit (ICU)-admitted patients had CK levels >1,000 U/L compared to only 4.7% of ICU-admitted COVID-19 patients. CONCLUSIONS HyperCKemia occurs in a similar frequency in COVID-19 and influenza infection. CK levels were lower in COVID-19 than in influenza in mild and severe disease. CK levels strongly correlate with disease severity and markers of inflammation. To date, it remains unclear whether hyperCKemia is due to a virus-triggered inflammatory response or direct muscle toxicity.
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Affiliation(s)
- Lea Pitscheider
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Mario Karolyi
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Francesco R Burkert
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Julia V Wanschitz
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Corinne Horlings
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Erich Pawelka
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Sara Omid
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Marianna Traugott
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Tamara Seitz
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Alexander Zoufaly
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | | | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Hospital, Zams, Austria
| | - Ronny Beer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefanie Seiwald
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang N Löscher
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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